Background: Entonox (N2O2) for decreasing labor pain is generally used intermittently. As continuous method is easier to use, we compared two methods in point of labor progression.Objectives: As entonox is used in numerous centers intermittently and it seems that continuous method has benefits such as more analgesic effect and easier usage, we decided to compare the effects of two methods on labor progress.Patients and Methods: This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. One hundred admitted women for vaginal delivery were included in this study. Fitted patients were randomly divided into equal groups. Fifty parturients used it intermittently and 50 persons used it continuously. Then labor progression, maternal and fetal conditions and satisfaction were registered and compared in two groups. Statistical analyses were performed by SPSS-17 software, t-test and c2 test.Results: The duration of three stages of labor was not different significantly. The mothers were more satisfied by continuous method meaningfully (P<0.0001).Conclusions: Our study showed continuous method had no adverse effects on labor progression and the satisfaction rate was more compared with intermittent method.

Aims: Aspiration of stomach contents is a serious side effect in patients with a feeding tube which can be prevented otherwise may lead to death. There have been disputes over the safest feeding method. Therefore, this study seeks to identify the chance of occurrence of respiratory aspiration in two tube feeding methods of intermittent bolus and intermittent drip bag.Methods: In this quasi-experimental study, 72 patients in ICU and trauma ward who were fed through tube, investigating contextual variables and using gradual method, were divided into two groups of intermittent bolus and intermittent drip bag method and both groups were independently fed for 3 days. After that, both groups were surveyed and compared based on the level of aspiration occurrence. To collect the data, personal information, nutrition, and respiration form as well as form of information about the two feeding methods in the studied units were utilized. The studied units were selected among Training and Treatment Centers in Rasht in 2010. To analyze the data, descriptive and inferential statistics and SPSS16 software were used.Results: The respiratory aspiration occurrence level in intermittent bolus tube feeding methods was 5.6% whereas this amount in intermittent drip bag method was zero. Fisher exact test revealed that there was no significant relationship between these two groups (p=0.47).Conclusion: As there was no significant relationship in respiratory aspiration between the two groups, it concluded that intermittent bolus method can still be mentioned in books as a standard method which can decrease the risk of aspiration if it is used properly.

Introduction: Fruits and their products in the dried form are good sources of vitamins, energy and minerals. However, during the process of drying or dehydration there are changes in quality parameters in dried products. Texture is one of the most important quality attributes of fruits during drying, reflecting their mechanical and microstructural properties. Apple is perishable fruit. Drying of apple is very important because of High losses are experienced during the seasonal glut. A novel process in food industry is the simultaneous infrared dry blanching and dehydration operation (SIRDBD) with intermittent heating method (radiation at constant temperature) exerted on fruits and vegetables that is known to enhance the quality of the final product. In the food industry, end-products must achieve a compromise between several properties, including sensory, sanitary and technological properties. Prediction of changes in texture during drying could be helpful in a better process control and improvement in overall acceptability of a dried snack food. The change of the elastic or viscoelastic texture of the fresh apples to rigid, fragile and brittle in the apple chips were evaluated by instrumental and sensory methods. Many attempts have been made to describe the viscoelastic behavior of dehydrated fruits and vegetables. Maxwell’ s or compression models are limited to homogeneous, isotropic materials. In contrast, texture profile analysis (TPA) is more suitable for heterogeneous biological materials and shows a good correlation with organoleptic evaluation. Typical TPA parameters are including hardness, adhesiveness, springiness, cohesiveness, gumminess, chewiness and resilience. In this research, for the first time, textural analysis of dried apple slices by infrared heating at different temperatures and different moisture levels was performed. Finally, the optimum texture and overall acceptance of the product are described according to the instrumental analysis. Materials and methods: Apples (Golden Delicious variety) were purchased from a local market and kept in 0° C± 1° C and relative humidity ranging from 90% to 95%. Before every thermal processing, the apple specimens were picked up from the cold storage and then they were put into use after reaching the ambient temperature. The samples were skinned manually and then cut into slices with different thicknesses of 5mm, 9mm and 13mm, all 20mm in diameter. The sliced apples were immediately subjected to simultaneous blanching and infrared drying. The texture of dehydrated apple slices using infrared radiation at three surface temperatures of 70, 75 and 80 ° C were studied. The product in three thicknesses was dried to achieve a moisture level of 15, 20 and 25% wet weight basis. Then, texture profile analysis (TPA) was carried out to 50% compression strain using texture analyzer. The sensory evaluation of dried slices was also considered for desire texture (Good mouth feels texture, lack of hard tissue, no shrinkage) and overall acceptance (The final acceptability of the product in terms of total sensory properties including color, texture, flavor and aroma) by 10 professional panelists. For statistical analysis, a completely randomized design (CRD) was used in a factorial form (3 3 ) and Duncan test with 95% confidence level. Result & Discussion: The results showed that drying to studied moisture levels reduced the hardness and adhesiveness and increased springiness, cohesiveness, gumminess, chewiness and resilience in comparison with raw apple tissue. Hardness of samples dried at higher temperature was higher due to rapid removal of moisture which might have caused collapse of capillary voids inside the product. Due to shrinkage samples became denser and thus a larger fracture force was to be expected. As water content increases (i. e., higher RH) water plasticizes the cell walls and the material and product becomes softer and more pliable, thus hardness decreases. The increase of hardness could be because the rapid mass transfer that damaged the membrane and cell structure of the fruits during drying. Another important factor responsible for the increase of hardness of finish-dried samples is the low final moisture content when compared with other samples. High temperature drying method enables samples to reach low moisture content at relatively short duration and therefore the product with harder texture was obtained. The maximum value of adhesiveness was observed for fresh apples, which could be attributed to the high moisture and sugar content. Adhesiveness decreased with moisture loss, indicating the availability of free water on the sample surface. A significant decrease in springiness following hightemperature drying could be attributed to the glass transition phenomenon and changes from elastic to plastic behavior. In the period of softening, cohesiveness increased with moisture loss. Hardening caused a decrease in cohesiveness depending on the drying temperature. Gumminess is the energy required to disintegrate a semisolid food to a state of readiness for swallowing. High values of gumminess revealed “ firm” and “ crisp” with a cell rupture mode of tissue failure and lowest values of gumminess could be classified as “ soft” . At the end of drying and with apple hardening, chewiness increased to values equal or above initial chewiness, indicating that a larger amount of energy is needed to masticate dried apples. Resilience had increasing with moisture loss. By increasing the thickness of the slices, the cohesiveness and springiness decreased and hence chewiness significantly decreased. The overall acceptance and desire texture in dried samples was observed at lower water evaporation rate conditions (lower temperatures, lower thickness and higher moisture content). In these conditions, the hardness of apple slices tissue was equal to 695. 177 ± 7. 685 grams. During drying of the apple, textural behavior was varied from the viscoelastic (higher initial hardness, with cohesiveness, springiness and lower resilience) to elastic and then to plastic or glassy.

Introduction: Numerous studies have indicated the superiority of enteral nutrition compared to parenteral nutrition. The frequency of enteral nutrition-related gastrointestinal complications in critically ill patients is high. Enteral nutrition (gavage) has complications such as diarrhea, nausea, vomiting and gavage intolerance (the residual volume of that which is aspirated from stomach is greater than 50% of the volume that is infused), which may cause fluid and electrolyte imbalance. The goal of this study was to compare the above complications between bolus, intermittent and continuous methods of gavage in surgical intensive care unit (SICU) patients.Materials and methods: After approval of the proposal by the Ethics Committee and obtaining the patients' informed consent, this clinical trial was conducted on 63 SICU patients. Patients were randomly divided into three groups. The methods of gavage used in the three groups were bolus, intermittent and continuous. Data collection was conducted using a checklist on the gavage method and complication data. Statistical analysis was performed with ANOVA and Pearson correlation coefficient was determined.Results: The study showed that the incidence of diarrhea, nausea, and vomiting was not significantly different between the three groups. This study shows that the incidence of diarrhea, nausea and vomiting was not significant between the three groups. Mean+SD durations of gavage tolerance in bolus, intermittent and continuous groups were 13.71+2.19, 13.95+1.35, and 14.85+0.47, respectively. The tolerance of gavage was significantly higher in the continuous groups compared to the bolus group (P<0.05).Conclusions: This study showed that the continuous method of gavage in SICU patients is better tolerated than the bolus method.

Labor pain is one of the most tiresome types of pain. So human has been seeking to allay this pain until now. Administration of a suitable agent such as Entonox during labor is very beneficial for childbirth outcomes. Entonox can be administered in two ways: intermittently and continuously. The aim of this study is to demonstrate whether continuous method is as safe as intermittent method? This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. One hundred admitted women for vaginal delivery were included in this study. Fitted patients were randomly divided into two equal groups. After thorough training, the patients used Entonox during active phase of labor. Fifty parturients used it intermittently and 50 others used it continuously. Then, maternal adverse effects, satisfaction and labor progression were registered and compared in two groups. Statistical Analysis was performed by spss17 software, t-test and chi square test. The maternal side effects of Entonox had no significant difference in two groups (p>0. 05). Mothers’ satisfaction rate in continuous group was more than the intermittent group significantly (p<0. 001). Meantime of active phase of labor had no significant difference between two groups (p=0. 2). It seems that by more investigations, there will be conditions for mothers to choose the desired method of Entonox usage, intermittently or continuously. This approach leads to reduction of difficult labor and cesarean section and consequently helps improvement of maternal health level, both physically and psychologically.

Introduction: Dehydration of fruits and vegetables is a widely used unit operation (Funebo et al., 2000). Intermittent infrared radiation, in which the product surface maintained at constant temperature, is a novel drying method to produce high quality dehydrated fruits and vegetables (Zhu and Pan, 2009; Zhu et al., 2010). During the drying, one of the most important physical changes in the quality of food is the decrease in external volume. This change in volume is called shrinkage and is an unavoidable phenomenon during the dehydration process. Shrinkage is usually expressed by the ratio between the volume of the sample after and before drying (Yan et al., 2008). Shrinkage also affects the porosity of dried materials and it is the parameter determining about the mass transfer properties, mechanical properties, and the texture of food product (Witrowa-Rajchert and Rzą ca, 2009). The three qualitative parameters such as the degree of shrinkage, density and firmness of the product are related to each other (Funebo et al., 2000). Maximal shrinkage and structural collapse were shown to decrease until kept quality characteristics (Barzaghi et al., 2008). The factors affecting shrinkage include volume of water extracted from the product, mechanical mobility of the solid matrix, drying rate, and process conditions such as temperature, air flow rate, and relative air humidity (Moreira et al., 2000). The mechanical mobility of texture in plant based foods during processing is affected by dry matter, starch and cell wall constituents, and it can be said that due to the high thickness of the cell wall, cell separation due to water evaporation pressure is more than cell rupture (Sabbaghi et al., 2017). The important consequences of shrinkage occurring during drying result in a loss of rehydration ability. Dehydrated products are usually rehydrated prior to their use (Krokida and Marinos-Kouris, 2003). The rehydration behavior is studied as an indicator of texture damage (Giraldo et al., 2006). Rehydration is a complex process that is intended to restore the properties of the fresh product by contacting dehydrated products with a liquid phase. This process to be composed of three simultaneous steps: (1) absorption of water into the dry material, (2) swelling of the rehydrated product, and (3) loss or diffusion of soluble components. Rehydration ability or capacity measures the ability of a dehydrated product to rehydrate (Maldonado et al., 2010). Mathematical models of rehydration will be useful in designing and optimizing this operation that have been applied as exponential models or capillary absorption theory or Fick’ s diffusion laws (Lee et al., 2006). In this research, the effect of this heating method on the physical-qualitative characteristics of dried apple slices, including volume, density, shrinkage and behavior of rehydration were studied. Material and methods: Apples (Golden Delicious variety) were purchased from a local market and according to Acevedo et al., 2008 kept in 0° C± 1° C and relative humidity ranging from 90% to 95%. The samples were skinned manually and then cut into slices with different thicknesses of 5mm, 9mm and 13mm and all with 20mm in diameter. The average moisture content of apple was measured using oven (Binder FD53) at 103 ° C for 24 hours and it was equal to 84. 11% based on wet weight (AOAC, 2000). Operation of infrared radiation with intermittent heating method was performed at three constant temperatures of 70, 75 and 80 ° C using the infrared dryer similar to Liu et al., 2014. Shrinkage coefficient of product was estimated with both theoretical (β theo) and practical (β ) methods according to Talla et al., 2004. Also, the mathematical models as Peleg (Reyes et al., 2011) and Exponential (Krokida et al., 2003) equation were compared to describe the rehydration process in dried product using adjusted R-squared (Adj. R 2 ) and root mean squared error (RMSE). Statistical analysis of the effect of thickness and temperature on the shrinkage coefficients (β theo, β ) was performed in SPSS software in version of 19. To achieve this aim, a completely randomized design (CRD) with factorial arrangement with two factors as thickness (at three levels) and temperature (at three levels) was used. Also, two methods of computing the shrinkage coefficients (theoretical and practical) were compared together with one-way F test. Mean comparison was performed by Duncan test with 95% confidence level (P<0. 05). All experiments were performed in three replications. Results and discussion: The results showed that increasing of the temperature caused greater volume and density changes during rapid dehydration of the product. The density changes were more intense for the thin product (reducing the final density to about 0. 6 g/cm 3 ). Also for thicker products, the density changes were slower during the process (reducing the final density to about 0. 7 g/cm 3 ). During process, the variation of product shrinkage indicated an exponential rising trend which was influenced by the amount of evaporated water. Shrinkage coefficient is significantly increased at higher processing temperature and thickness of product (β equal to 0. 164), representing that the product is heavily affected by the structural collapse phenomenon. The observations were similar to those reported by many researchers (Mayor and Sereno, 2004; Nowak and Lewicki, 2004; Katekawa and Silva, 2006). The temperature of 80 ° C showed significantly higher theoretical and practical shrinkage coefficient than the other two tested temperatures (70, 75 ° C). The difference between the two methods of calculation in shrinkage coefficient (theoretical and practical) was also significant and the difference increased with the increase of temperature (more than 6%). Jannot et al., 2002 reported that the error in the practical method can be due to the noisy data (deviation from the actual value). Limitation of rehydration capacity (RC) in slices with high shrinkage stress confirms the damage of the texture of the product (reduction in predicted equilibrium moisture content: Xe from 6. 523 to 4. 148 kg/kg, db). Rehydration process in different product thicknesses is described better using Peleg model (higher Adj. R 2 and lower RMSE) compared with the exponential one. The observations were similar to those reported by many researchers (Krokida and Marinos-Kouris, 2003; Nathakaranakule et al., 2010). Conclusion: The physical properties including shrinkage and density in the dried product are affected by process and product conditions. The low occurred shrinkage that reflects the preservation of the internal structure of the product and will be effective in rehydration behavior. In fact, reabsorption cannot be simply defined as the returned process of dehydration. Because of moisture reabsorption is completely affected by the texture, structure and properties of the dried product. Therefore, mild thermal conditions prevent the structural breakdown of apple slices and, at low thicknesses, due to the reduced volume of water evaporated from the slices, the shrinkage coefficient is reduced, thus preserving the internal physical structure of the infrared dried product.

Introduction: Aspiration-induced pneumonia is responsible for 15-20% of hospital infections and a 39% increase in costs. Besides, it is one of the ten leading causes of death in the USA. It can be prevented by choosing the feeding method. This study aimed to assess the incidence of respiratory aspiration using the tube feeding method of intermittent drip bag. Methods: This one group only post-test study was conducted on 36 ICU trauma patients. The patients were fed using the tube feeding method of intermittent drip bag for three days, each time with 150 to 300 cc liquid nourishing solution for 30 to 60 minutes with three-hour intervals. To detect respiratory aspiration, 0. 5 cc of methylene blue 1% was added to 500 cc of the liquid. In case the patients needed suction, whenever the blue color of methylene blue was observed in the lung secretions during suction of the respiratory tube, incidence of respiratory aspiration was ascertained. The data were collected using Demographic information registration form and Clinical Information Registration Questionnaire. Then, the data were analyzed using SPSS V19 and descriptive and analytic statistics. Results: The results revealed no incidence of respiratory aspiration via the tube feeding method of intermittent drip bag during three consecutive days. Conclusion: The present study indicated no respiratory aspiration observed using the tube feeding method of intermittent drip bag, this method can be utilized in the centers that are not equipped with feeding pump. Moreover, using feeding bags instead of feeding pumps plays a key role in reducing related costs.

Infrared radiation by intermittent heating is a novel method in which the surface temperature of the product is maintained at a constant value. This method is widely used in simultaneous blanching and drying process. The main advantages of intermittent IR-radiation are energy saving and preventing undesirable quality changes in the final product. The calculations of mass transfer in this process can be used to estimate the temperature and time conditions in the process. For this purpose, drying behavior of apples slices (Golden Delicious variety) was investigated with slab shape in three different sizes: thickness of 5, 9 and 13 mm and length and width was 20 mm. Heating operation performed by infrared dryer that was equipped with controller of product surface temperatures at 70, 75 and 80oC. Kinetic models such as Newton, Page, Modified Page, Henderson-Pabis and parabolic were fitted on experimental data of dimensionless moisture ratio using MATLAB software. The adjusted correlation coefficient (Adj.R2) and root mean square error (RMSE) were used to compare the models. The evaluation of effective moisture diffusivity (Deff) performed during drying of slices and its dependency with temperature investigated using Arrhenius equation. The results showed that models of page and parabolic presented a good fit on experimental data, respectively (higher Adj.R2 and lower RMSE). The effective diffusion coefficient significantly elevated with an increase in surface temperature and thickness. This parameter showed higher energy activation for lower thicknesses that indicated a greater irradiation temperature dependence of effective diffusion coefficient through the decreasing of thickness.